Virginia's 'to whom it may concern' TB clearance documents the result of a TB evaluation for an employer, school, child care program or college. The evaluator works through a risk assessment and symptom screen, TST or IGRA results and any chest x-ray, then signs one of two conclusions: free of tuberculosis in a communicable form, or active TB cannot be ruled out and the person has been referred.
The health department, facility or clinician that performed the evaluation completes Sections I to V; the signer must be a clinician with prescriptive authority or a health department official.
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Report of Tuberculosis Screening
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The signature line is for a clinician with prescriptive authority or a health department official. The form also names the health department, facility or clinician that evaluated the person, then records the conclusion in Section V.
No. If the TB risk assessment finds no symptoms and no risk factors, Section I states that a TST or IGRA is not indicated, and the evaluator moves to Section V. A person with a history of TB infection and no symptoms also needs no follow-up chest x-ray under Section I.